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. 2015 May;29(3):220-31.
doi: 10.1111/ppe.12190. Epub 2015 Apr 5.

Can drug effects explain the recent temporal increase in atonic postpartum haemorrhage?

K S Joseph  1 , Odile Sheehy, Azar Mehrabadi, Marcelo L Urquia, Jennifer A Hutcheon, Michael Kramer, Anick Bérard
Affiliations

Can drug effects explain the recent temporal increase in atonic postpartum haemorrhage?

K S Joseph et al. Paediatr Perinat Epidemiol. 2015 May.

Abstract

Background: Rates of postpartum haemorrhage and atonic postpartum haemorrhage have increased in several high-income countries. We carried out a study to examine if drug use in pregnancy, or drug and other interactions, explained this increase in postpartum haemorrhage.

Methods: The linked administrative and hospital databases of the Québec Pregnancy Cohort were used to define a cohort of pregnant women in Québec, Canada, from 1998 to 2009 (n = 138,704). Case-control studies on any postpartum haemorrhage and atonic postpartum haemorrhage were carried out within this population, with up to five controls randomly selected for each case after matching on index date and hospital of delivery (incidence density sampling). Conditional logistic regression was used to estimate the effects of drug use on postpartum haemorrhage and atonic postpartum haemorrhage.

Results: There was an unexpected non-linear, declining temporal pattern in postpartum haemorrhage and atonic postpartum haemorrhage between 1998 and 2009. Use of antidepressants (mainly selective serotonin reuptake inhibitors) was associated with higher rates of postpartum haemorrhage [adjusted rate ratio (aRR) 1.48, 95% confidence interval (CI) 1.23, 1.77] and atonic postpartum haemorrhage [aRR 1.40, 95% CI 1.13, 1.74]. Thrombocytopenia was also associated with higher rates of postpartum haemorrhage [aRR 1.52, 95% CI 1.16, 2.00]. There were no statistically significant drug interactions. Adjustment for maternal factors and drug use had little effect on temporal trends in postpartum haemorrhage and atonic postpartum haemorrhage.

Conclusions: Although antidepressant use and thrombocytopenia were associated with higher rates of atonic postpartum haemorrhage, antidepressant and other drug use did not explain temporal trends in postpartum haemorrhage.

Keywords: Atonic postpartum hemorrhage; etiology; selective serotonin reuptake inhibitors; temporal trends; thrombocytopenia.

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Figures

Figure 1
Figure 1
Rates of postpartum haemorrhage and atonic postpartum haemorrhage among pregnant women in the study population, Québec Pregnancy Cohort, 1998–2009.
See this image and copyright information in PMC

References

    1. Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics 2007; 98:237–243. - PubMed
    1. Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF. Investigation of an increase in postpartum haemorrhage in Canada. BJOG: An International Journal of Obstetrics and Gynaecology 2007; 114:751–759. - PubMed
    1. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier‐Colle MH, Ford JB, et al Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy and Childbirth 2009; 9:55. - PMC - PubMed
    1. Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. American Journal of Obstetrics and Gynecology 2010; 202:353, e351–e356. - PubMed
    1. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesthesia and Analgesia 2010; 110:1368–1373. - PubMed

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